Cigna enters value-based agreement with Heal in four states
Cigna's Medicare Advantage customers in those states will immediately have access to the full spectrum of in-home primary care services.
Photo: Supersizer/Getty Images
Cigna has teamed with Heal in a value-based arrangement whereby the latter will be in-network for Cigna Medicare Advantage customers, providing in-home primary care for seniors, the insurer said last week.
The partnership will take root in four states – Georgia, Illinois, North Carolina and South Carolina – and Cigna's Medicare Advantage customers in those states will immediately have access to the full spectrum of in-home primary care services.
Heal said its services, which are geared specifically for seniors, include house calls, telehealth and remote patient monitoring.
WHAT'S THE IMPACT
Heal CEO Scott Vertrees said the collaboration will allow the company to provide comprehensive home care for more seniors, which will range from chronic conditions to sick visits and preventive care.
Over the last few years, Heal said it has experienced significant growth, including a 450% increase since 2021 in the number of seniors choosing it as their primary care provider.
Additionally, the latest Independence at Home demonstration by the Centers for Medicare and Medicaid Services (CMS) revealed that Heal's home-based primary care model lowered Medicare costs for chronically ill patients by 20%.
"Cigna aims to improve all aspects of our customer's health and well-being, and providing in-network coverage for quality, affordable, and convenient health care is one way we do this," said Dr. J.B. Sobel, chief medical officer of Cigna Medicare.
The agreement includes all Heal service areas in Georgia, Illinois, North Carolina and South Carolina.
THE LARGER TREND
The Department of Justice filed a civil lawsuit in October against Cigna and its Medicare Advantage subsidiaries alleging that it sought to boost its reimbursement by submitting false and inaccurate Medicare Advantage diagnostic codes.
The lawsuit seeks damages and penalties under the False Claims Act for the submissions, which the DOJ claims was used to artificially inflate the payments Cigna received for its MA coverage. The government is intervening in a lawsuit initially filed by a whistleblower, which was originally filed in the United States District Court for the Southern District of New York and later transferred to the Middle District of Tennessee.
Meanwhile, in September, the American Medical Association accused Cigna of underpaying claims filed by providers in the contracted MultiPlan network, the largest third-party network in the country. The AMA has joined a class-action lawsuit alleging the insurer reimbursed for claims at non-participating providers' rates rather than the expected MultiPlan contract rates.
Cigna said in August that its health plans will be available on the individual exchange in three new states during open enrollment – Texas, Indiana and South Carolina – as well as in additional counties in Georgia, Mississippi and North Carolina.
With the expansion, which is still pending final regulatory approvals, Cigna will offer individual and family plans on the individual exchanges in 363 counties spanning 16 states – Arizona, Colorado, Florida, Georgia, Indiana, Illinois, Kansas, Mississippi, Missouri, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Utah and Virginia. These new markets have the potential to reach about 730,000 additional customers in 2023, the insurer said.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
